Comparative Study Of Transforminal Lumbar Interbody Fusion And Posterior Lumbar Interbody Fusion In Treatment Of Degenerative Lumbar Disease

Objective:1. To investigate short-term clinical efficacy of the treatment in degenerative lumbar disease using transforaminal lumbar interbody fusion technique combined with posterior pedicle screw instrumentation.2. To compare clinical effect, Range of motion (ROM) of the instrumented and upper adjacent level and complications between transforaminal lumbar interbody fusion and posterior lumbar interbody fusion, At the same time, we also describe indications, advantages and disadvantages of transforaminal lumbar interbody fusion technique.Methods:Patient selection consisted of those presenting with low back pain or radiculopathy who have failed in nonoperative management at least 6 months. All patients had evidence of degenerative disc disease with interbody height loss or evidence of instability. This is a retrospective review of 71 patients with degenerative lumbar disease who were treated with transforaminal lumbar interbody fusion (TLIF group) or posterior lumbar interbody fusion (PLIF group) from January 2008 to February 2010. All of patients were followed up, the mean follow-up time was 24months(range,12 to 36 months). The operation time, blood loss, postoperative drainage, postoperative hospital stay and complications of all cases were recorded. Low back pain (LBP) and leg pain at preoperative and final follow-up were evaluated according to Visual Analogue Scale (VAS), and the function was evaluated by Oswestry Disability Index (ODI). Flexion-extension radiographs were taken separately and Range of motion (ROM) of the instrumented and upper adjacent level were measured. We compared the operation time, blood loss, postoperative drainage and postoperative hospital stay between TLIF and PLIF group. VAS scales of LBP and leg pain, ODI, ROM of the instrumented and upper adjacent level, interbody height of the instrumented level, lumbar lordosis were compared between preoperative and postoperative in the TLIF group and PLIF group, at the same time, preoperative and postoperative were also compared between TLIF group and PLIF group. Patients who have the following cases are excluded, such as severe osteoporosis, lumbar disc herniation accompanied by severe lumbar spinal stenosis, poor control of hypertension and diabetes, site infection or refuse to be followed-up.Results:There were 21 patients in TLIF group and 50 patients in PLIF group. The operation time, blood loss, postoperative drainage and postoperative hospital stay in the TLIF group were significantly less than those in the group of PLIF (P<0.05). VAS scales of LBP, leg pain and ODI of the final follow-up were significantly lower than preoperative in both groups(P<0.05). Between groups, however, there were no significant differences neither at preoperative or final follow-up (P>0.05). Postoperative interbody height of the instrumented level, lumbar lordosis were higher than the preoperative in both groups (P<0.05), however, no significant differences were found in terms of interbody height of the instrumented level and lumbar lordosis at preoperative and postoperative between groups (P>0.05). ROM of the instrumented level at the final follow-up were significantly lower than preoperative in both groups (P<0.05), however, there were no significant differences neither at preoperative or final follow-up between groups (P>0.05). ROM of the upper adjacent level at the final follow-up in the group of TILF was similar to the preoperative (P>0.05), whereas, that in group of PLIF was markedly increased at the final follow-up compared with preoperative (P<0.05). It was significantly higher in terms of ROM of the upper adjacent level at the final follow-up than preoperative in the group of PLIF (P<0.05), though no significant differences were found at preoperative between the two groups (P>0.05). There were 1 complication (postoperative radiculitis) in the group of TLIF and 15 patients with complications (6 cases with dural tear,7 with postoperative radiculitis,2 with cage subsidence) in the group of PLIF. All patients achieved fusion in the current study at the final follow-up,and fusion rate was 100%.Conclusion:1. The techniques of TLIF and PLIF are effective in treating degenerative lumbar disease, which obtaining satisfactory clinical efficacy in short term.2. The operation time, blood loss, postoperative hospital stay, postoperative drainage and complication using TLIF are less than that using PLIF.3. Compared with the technique of PLIF, the integrity of posterior ligamentous complex were retained more effectively through the technique of TLIF, and it also reduces the ROM of the upper adjacent segment.